What happens if my health insurance claim is rejected by the insurer?

First, request the insurer's written reasons for rejection in detail if you haven't already received them clearly, and review this against your policy document carefully to understand whether the stated ground for rejection actually applies to your specific situation.

If you believe the rejection is unjustified, you can first escalate through the insurer's own internal grievance redressal mechanism, and if unresolved, approach the Insurance Ombudsman for smaller value disputes, which offers a relatively quick, cost-free process. For larger claims, or if you're not satisfied with the ombudsman's outcome, you can file a complaint before the Consumer Commission, treating the wrongful rejection as a deficiency in service.

Common disputed grounds include non-disclosure of a pre-existing condition, or a claimed policy exclusion the insurer is applying — whether these hold up depends closely on your specific policy wording and medical history. It would help to have a lawyer review your policy document, the rejection letter, and your medical records together to assess how strong your case for challenging the rejection is.